遡及的検討が可能であった表層拡大型食道癌の1例

Superficial Spreading Type of Eso-phageal Carcinoma ; Retrospective Study, Report of a Case

要旨　52歳男性．食道検査のため秋田大学附属病院を紹介された．患者は胃潰瘍の経過観察中の内視鏡およびX線検査で食道病変を指摘された．内視鏡検査では切歯列から26～35cmの部位に顆粒像を示す表層拡大病変がみられた．生検像では扁平上皮癌であった．胸部食道摘出術，食道胃吻合術，幽門形成術が施行された．組織学的には中分化型扁平上皮癌で，一部粘膜下層へ浸潤していた．患者は入院19カ月前にも同部位に小病変を指摘されていたが，生検で悪性所見は得られなかった．遡及的検討で食道癌の初期病変と推定できた．19カ月後の検査で病変の増大が観察できた．

　A 52 year-old man was admitted to Akita University Hospital because of esophageal examination. He was pointed out to have an esophageal lesion by endoscopic and radiologic examination during the followup study of gastric ulcer. Endoscopic examination revealed a superficial spreading lesion with granular surface at 26 to 35 cm distal from the incisor. Biopsy specimens showed squamous cell carcinoma. Thoracic esophagectomy with esophagogastrostomy and pyloroplasty was performed. Histologically, moderately differentiated squamous cell carcinoma was seen, partly invading into the submucosa. A small lesion was later recognized at the same site 19 months before admission, but the biopsy specimens failed to show malignancy. But, it was assumed that the initial lesion of esophageal carcinoma was found only by retrospective investigation. Growth of this lesion was observed by the second examination 19 months later.